Preoperative Patient Assessment

Patient Assessment

The perioperative staff should assess the patient preoperatively for potential contraindications and risks [1]. The final decision on whether or not to use a tourniquet rests with the attending physician.

Potential contraindications for tourniquet use

Perioperative staff should screen the patient preoperatively for the following potential contraindications [1]:

  • Venous thromboembolism,
  • Impaired circulation or peripheral vascular compromise,
  • Previous revascularization of the extremity,
  • Extremities with dialysis access,
  • Acidosis,
  • Sickle cell anemia,
  • Extremity infection,
  • Tumor distal to the tourniquet,
  • Medications and supplements,
  • History of pain or weakness in muscles or bones in extremities,
  • Open fracture, and
  • Increased intracranial pressure.

Considerations related to tourniquet use

Perioperative staff should assess the patient for considerations related to tourniquet use, including [1]:

  • Planned location of the tourniquet
    • Risk of injury to the underlying nerves and vessels may be decreased if the tourniquet is applied to an area of the limb where there is the most soft tissues
  • Limb size and shape at the planned location
    • Selecting a cuff that is not appropriately sized for the limb can result in failure to sustain occlusion at normal pressures, and loosening or shifting of the cuff during use, leading to loss of occlusion and skin injury
    • Patients with large limbs (large adults and bariatric patients) may require higher tourniquet pressures and should use tourniquet cuffs designed for these populations
    • Patients with small limbs (small adults and pediatric patients) should use tourniquet cuffs designed for these populations
    • Patients with cylindrically shaped limbs should use cylindrical cuffs
    • Patients with tapered limbs should use variable-contour cuffs. Click here to learn more about cylindrical and variable-contour cuffs.
  • Skin condition at the planned location
    • Risk of cuff shifting during use may be increased when a tourniquet cuff is applied to a patient with loose limb tissue. Cuff shifting may cause frictional burn, pinching, and mechanical shearing of the tissue.
    • Matching limb protection sleeves should be used to help protect the soft tissues underneath the cuff. These sleeves reduce wrinkling, pinching, and mechanical shearing of the tissue. Click here to learn more about matching limb protection sleeves.
  • Patient’s circulatory system
    • Baseline measurement of peripheral pulses helps to evaluate the risk of applying a tourniquet to the patient’s limb
    • Indicators of poor circulatory nutrition include brittle, dry nails; shining or scaly skin; and extremity hair loss.
    • Other circulatory considerations include capillary filling time and the presence of varicose veins.


[1] AORN. Recommended practices for care of patients undergoing pneumatic tourniquet-assisted procedures. In: Perioperative Standards and Recommended Practices. AORN, Inc.; 2015.